Authors´ conclusions: mebeverine was ineffective in treatment of pediatric irritable bowel syndrome and functional abdominal pain not otherwise specified. However, a positive drug label significantly enhanced treatment outcomes compared with a blinded trial label.
Reviewers´ commentary: mebeverine did not show efficacy compared to placebo in functional abdominal pain in adolescents, whereas positive labelling did produce a clinically relevant effect. These results are applicable to pediatric practice and reinforce the importance of expectations and therapeutic communication in the management of functional abdominal pain.
Balado Insunza MN, Llerena Santa Cruz E. Evid Pediatr. 2026;22:24
Authors´ conclusions: in children aged 0 to 18 years with uncomplicated acute appendicitis nonoperative management (NOM) management with antibiotics is associated with significantly higher rates of initial, one-year after discharge, and overall treatment failure compared with appendectomy. Non-surgical management was associated with a higher frequency of adverse events, longer hospital stays, and a higher rate of rehospitalization. Surgery remains the primary treatment strategy, while NOM could be considered for select cases with careful risk-benefit evaluation.
Reviewers´ commentary: the study demonstrates the superiority of appendectomy over antibiotic therapy alone for uncomplicated appendicitis in children aged 0 to 18 years. The diversity of the antibiotic treatments included and the small number of included trials limit the generalizability of the results. Appendectomy should remain the treatment of first choice in pediatric patients.
Author´s conclusions: treatment with GLP-1 receptor agonists improves glucometric parameters in patients with type 2 diabetes and weight-related data in patients with obesity or diabetes, without affecting the lipid profile. Side effects are primarily gastrointestinal. Short-term data suggest no behavioral changes or suicidal ideation.
Reviewer´s commentary: the study shows modest beneficial effects on glycaemic parameters and body weight in patients with type 2 diabetes and/or obesity. However, it has methodological weaknesses, a risk of conflict of interest in the primary studies, and limited data on long-term safety.
Espínola Docio B, Rivero Martín MJ. Evid Pediatr. 2026;22:26
Authors´ conclusions: mass administration of azithromycin in Mali, limited to infants 1 to 11 months of age, did not result in lower infant or child mortality than placebo, regardless of whether azithromycin was delivered twice yearly or quarterly.
Reviewers´ commentary: infant mortality in the poorest countries could be reduced through the administration of azithromycin several times a year. Its effect would be related to a reduction in infections. In this study, the use in children aged 1 to 11 months does not appear to influence reducing mortality. This lack of effect, together with the potential increase in antimicrobial resistance, makes it advisable to seek new strategies to decrease infant mortality.
Authors´ conclusions: in this network meta-analysis, no significant differences were observed in the efficacy of commonly used corticosteroid regimens for acute exacerbations of childhood asthma. Nevertheless, they suggest that short-term oral dexamethasone could be an acceptable alternative to longer-term treatment with prednisolone.
Reviewers´ commentary: network meta-analysis results suggest that prednisolone (2.0 mg/kg/day for 5 days) is the preferred regimen for relapse, and dexamethasone (0.3 mg/kg/day for 1 day) for admission. However, given the substantial imprecision in effect estimates, it remains uncertain whether higher prednisolone doses reduce relapse or admission risks compared to one-day dexamethasone. The effect size remains unquantifiable due to statistical non-significance; thus, more powerful studies are needed to support clinical decisions.
Gutiérrez Medina P, Ortega Páez E. Evid Pediatr. 2026;22:28
Authors’ conclusions: smartphone ownership is associated with depression, obesity, and insufficient sleep in early adolescence, and this influence is greater the younger the user is. This should give parents and authorities pause for thought.
Reviewers´ commentary: early smartphone ownership in adolescents is associated with a higher probability of obesity, depression, and insufficient sleep, although the study does not establish a causal relationship. Despite its limitations, the longitudinal design, large sample size, adjustment for confounding factors, and specially the longitudinal analysis —methodologically the most robust, as it adjusts for baseline status of the outcome— strengthen the validity of the findings. These results support the need to reflect on the appropriate age for smartphone acquisition and to promote supervision and digital education strategies in clinical practice.
Moreno Sánchez A, Martínez Rubio MV. Evid Pediatr. 2026;22:29
Authors´ conclusions: there was no evidence that high-dose, daily oral insulin prevents the development of islet autoantibodies. Further studies are needed to assess the benefit of primary oral insulin therapy for preventing diabetes in genotype-selected infants.
Reviewers´ commentary: currently, oral insulin cannot be recommended as a treatment to delay the onset of type 1 diabetes in at-risk populations. The emergence of other promising therapies, such as teplizumab, is likely to influence the development of new clinical trials. If a subgroup of patients in whom it proves effective were identified, differences in cost and safety profile among these options would need to be assessed.
Pérez Solís D, Fraile Astorga G. Evid Pediatr. 2026;22:30
Author´s conclusions: prenatal exposure to endocrine disruptors is significantly associated with an increased risk of urogenital and cardiac malformations. These findings support the implementation of stricter preventive strategies to protect fetal health and reduce the surgical burden in the pediatric population.
Reviewer´s commentary: the results of this systematic review and meta-analysis suggest a link between endocrine disruptor exposure and the development of congenital urogenital and cardiac anomalies. Nevertheless, methodological limitations of the analyzed studies and their marked heterogeneity preclude the establishment of conclusive evidence-based recommendations.
Rivero Martín MJ, Gutiérrez Medina P. Evid Pediatr. 2026;22:31
Authors´ conclusions: children exposed to radiation for medical imaging have a low risk of developing hematological malignancies. This association cannot be attributed to chance, as a dose-response relationship exists between the cumulative dose in bone marrow and the risk of developing hematological malignancy.
Reviewers´ commentary: this study provides evidence that radiation from medical imaging is associated with an increased risk of hematological malignancies in children, even at doses below 50 mGy. Therefore, it is necessary to carefully weigh the benefits and risks when performing imaging studies in children to minimize radiation exposure whenever possible.
Editorial
